Chris Aldren speaks to French ear surgeon Robert Vincent who’s particularly proud of forming a global otologist network providing free resources for education and patient care worldwide.
Robert Vincent
Robert, who have been your otological mentors?
I did my initial ENT training in Nancy, France, where I studied under Professor Wayoff who first introduced me to stapes surgery. In 1990 I took a short observership at the Clinique Causse here in Colombiers and met Jean Bernard Causse. We got on well and he offered me a post at the clinic where I have worked ever since. Initially I was in the outpatient department but soon started operating under his expert guidance. He taught me the vein graft technique for stapedotomy which I continue to use today. My other great influence, not just for understanding the middle ear pathophysiology, but also for understanding humanity, was the great Israeli otologist Jacob Sade who was a frequent guest of the clinic. Outside of medicine, my parents were a huge influence. From my mother I learned rigour and from my father, sociability. I owe them everything.
"Always enter your operative data into a database so you can look objectively at your own results over time"
Robert performing otologic surgery at the Causse Ear Clinic.
What are your top surgical tips for younger surgeons?
Never say ‘it’s good enough’ when reconstructing an ossicular chain. Always strive for the very best. You need to measure and if you are unhappy with your reconstruction, start again. I like to use prostheses with a hydroxyapatite (HA) head as it allows me to drill the head to alter a prosthesis to fit the anatomy. This is especially important for revision and congenital cases. Also, HA does not require a cartilage cover, so it allows a more precise reconstruction. Always enter your operative data into a database so you can look objectively at your own results over time.
Can you explain why you developed the otology neurotology database?
Well, when I joined the Causse clinic, if we wanted to look at our results, we had to pull up all the old paper records and it was really time consuming. I wanted a straightforward, cheap database and, as there was not one available, I worked with Denis Alcaraz at the clinic to develop one. I think it is really good and use it for all my cases. It is quick to enter the data and is available at www.ondb.org for only €99. I must say, we make no profit from this but use the money to host the database and keep developing it. I know you use it, Chris.
You mentioned hydroxyapatite prostheses. Tell us why you developed your own designs?
I have always been happy with the Causse Teflon stapes piston and have never changed it but using the database, I realised my long-term results using partial ossicular prostheses PORPs were variable. I was using HA prostheses with bell coupling to sit on the stapes head and when I revised these cases I found they were quite unstable. I particularly noted this if they were under an anteriorly placed malleus handle.
"I wanted a straightforward, cheap database and, as there was not one available, I worked with Denis Alcaraz at the clinic to develop one"
With some chronic ears where the malleus had come away from the tympanic membrane, I was able to move the loose malleus posteriorly and I noted better results, so I thought why not try to move the malleus posteriorly even when it is attached to the tympanic membrane. This meant releasing it from the tympanic membrane, removing the incus, dividing the tensor tympani and pulling the malleus posteriorly to relocate it over the stapes footplate. This is my malleus relocation technique and allows a much more vertical reconstruction of the ossicular chain, which is not only more stable but also improves the sound transmission. I really noted a big improvement in my results and now use this all the time. However, I remained unhappy with the use of PORPs and was influenced by my friend, Bill Moretz, who told me he used a total ossicular replacement prothesis (TORP) even when the stapes was present and felt the results were better. So, I was trying to see how I could use the stapes to stabilise a total prosthesis and came up with the idea of linking the TORP to the stapes head with a silastic rubber band. At first, we cut the rubber bands by hand but they were a little tight, making them difficult to place and, on occasion, causing erosion of the stapes head over time. I then worked with Grace Medical and we created a prosthesis with a softer silastic band built onto the prosthesis shaft – this works really well.
The other prosthesis I developed was the malleus replacement prosthesis which I use when there is no malleus. This is made of titanium and is secured to the scutum using two pins. Obviously, I don’t use this so often, but it gives a really stable reconstruction in some of the most difficult cases.
Robert with his son, Romain, and daughter, Marion.
Chris Aldren and Robert Vincent in the Forbidden City, Beijing.
Robert enjoys mountain biking in his (limited!) spare time.
"I really try to emphasise the friendship we have as a faculty and try to spread that spirit of cooperation throughout the wider otological world"
You have been running your otology course at the clinic for over 20 years. Tell us about that.
When I started at the clinic in 1991, Jean Bernard would frequently travel abroad to teach and I used to go with him to the American Academy every year. Together we gave an instructional course and it was very popular. Some years later I was invited by John Oates to teach on an otology course in Burton and he suggested I should run one at the clinic in France. We are now about to have our 24th course www.clinique-causse.com/course2023/. Over the years the faculty has grown, and we have become a close group of friends. Although the course is centred on otology, with lectures, live surgery and round tables, I really try to emphasise the friendship we have as a faculty and try to spread that spirit of cooperation throughout the wider otological world. This year’s course is June 27-29 and is remarkably good value. There are scholarships available from the TWJ foundation in the UK and the Indian Society of Otology.
Your teaching has spread onto the internet with LION and your YouTube channel. How did that start?
Well, it is in the same spirit as the course to spread otology training as widely as possible. I got together a group of leading otologists in 2007 and we started to transmit live ear surgery free on the internet. We call it LION (live international otolaryngology network). Wilko Grolman hosted the session through a base in Utrecht and it has always been free to view. The surgeons talk as they operate and a group of moderators in the centre in Utrecht fields questions directly to the surgeons. The quality of transmission has increased over the years and is now superb. We have a library of previous operations and talks on the website www.lion-web.org. In the last few years, I have set up my own YouTube channel with over 500 surgeries which, again, is free to access.
Abdel Rahman El Bacha, a world-renowned pianist performs a recital at Nuits the Musicales de Mazaugues in 2018.
You are interested in classical music and run a festival in Mazaugues in Provence
Yes, I have been running Nuits Musicales de Mazaugues since 1986. Every summer, I put on three or four concerts in Mazaugues, the small town in Provence where I grew up and where I still own my old family home. They are usually small chamber concerts but with topflight professional musicians playing in a wonderful outdoor venue. Whilst I try to keep it as a festival for the local population, maybe some of the ENT & Audiology News readers would enjoy it!
Thank you, Robert, it has been a great pleasure talking to you and I look forward to seeing you at the clinic in June for the 24th Otology Course.
